Successful management of a high-output urinary fistula following radical cystectomy and ileal conduit: a conservative approach

Urinary leak following ileal conduit after a radical cystectomy is a rare yet serious complication which presents early in the postoperative period. We herein present a case of a 38-year-old man diagnosed with recurrent high-grade non-muscle invasive bladder carcinoma. He underwent robot-assisted radical cystectomy and bilateral pelvic lymph node dissection. Postoperatively, the patient developed a high output urinary fistula (800–1000 mL/day) which was confirmed by fluid creatinine levels and a contrast study. He was managed successfully with a conservative approach. The leak subsided in 6 weeks and on follow-up patient is doing well. Most of the literature favours a surgical approach in such cases, however with optimal nutritional support (enteral/parenteral), adequate diversion of urine, percutaneous drainage of undrained collections, adequate intravenous antibiotics and good nursing care, resurgery with its associated morbidity can be avoided resulting in successful outcomes.

Of Fistulas, Sutures, and Silences

Upon arrival at the Qasr al-ʿAyni Hospital in Cairo in 1908, a woman from a village in Qena province in Upper Egypt related her harrowing medical saga. It began when she developed a urinary fistula (nāsur bawlī) due to prolonged labor (a urinary fistula causes urine to leak from the bladder into the vagina, resulting in deep discomfort and social ostracism of those afflicted). She had gone to a hospital in the city of Qena, capital of the province with the same name, but medical officers there sent her to Asyut. There, in the government hospital, she underwent three operations without success, whereupon doctors instructed her to go to Qasr al-ʿAyni Hospital in Cairo to see Dr. Nagib Mahfuz (1882–1974), who had developed a reputation for his surgical prowess in treating fistulas. The woman from Qena traveled by foot, begging along the way, until, exhausted, she reached the city of Minya, halfway between Asyut and Bani Suwayf. There she was sent once again to the government hospital, examined, and once again told to go to Qasr al-ʿAyni.

Surgical Review

Ziemacki (Kharkov). On the question of the operation of the urinary fistula, vol. III, p. 98.

Gelatin sponge (Spongostan®) and N-butyl-2-cyanoacrylate: Utility on percutaneous treatment of persistent urinary leakage after partial nephrectomy. Case report and review of the literature

Introduction: Percutaneous treatment of persistent urinary fistula after partial nephrectomy using N-butyl-2-cyanoacrylate and gelatin sponge (Spongostan®) is an effective and relatively non-invasive procedure that should be considered when a conservative approach fails. Three successful cases of percutaneous embolization by using N-butyl-2-cyanoacrylate have been reported in the literature. To our knowledge, the use of Spongostan for the treatment of urinary fistula after partial nephrectomy has not been previously described. Case report: We present the case of an 82-year old man who underwent percutaneous closure of a urinary fistula following partial nephrectomy by using gelatin sponge (Spongostan®) and N-butyl-2-cyanoacrylate.Conclusions: We encourage the use of this technique in selected cases. Collaboration amongst urologists and skilled interventional radiologist is strongly recommended.

Extravasation of Urine Into the Superficial Perineal Space Due to Ureteral Necrosis after Kidney Transplantation: A Case Report

Background: Urinary fistula is a common complication of kidney transplantation. It may cause severe complications like graft loss and patient death.Case presentation: Here we present a recipient who developed graft ureteral necrosis with leakage of urine into the superficial perineal space but not into the peri-graft or the retroperitoneal space, as an unusual clinical feature. This may be due to dense adhesions in the peri-graft region and dam-like effect of adhesive spermatic cord and inferior epigastric vessels traversing across the graft ureter. Urine leaking out with high pressure extravasates through the potential gaps in the incision of aponeurosis at the lateral margin of the rectus abdominis and into the superficial perineal space. The proximal ureter of the graft was end-to-end anastomosed to the right ureter. Both the recipient and graft recovered well.Conclusions: Comparing the creatinine levels in the leaking fluid and serum is an effective way to confirm urinary fistula. Early aggressive management is a rational option for treatment of urinary fistula.